Ozempic: How a medication for diabetes went from weight-loss wonder-drug to a supposed cure for anything

Another day, another headline suggesting the new breed of diabetes and weight-loss drugs offer hope for another chronic disease.

This week it was kidney disease, according to a study that showed semaglutide — the active ingredient in medications sold under the brand names Ozempic, Rybelsus and Wegovy — may prevent kidney failure.

In another week it might have been heart disease, Alzheimer’s or alcoholism, all of which have been linked to positive outcomes from a class of drugs known as GLP-1 receptor agonists, the best known example of which is semaglutide.

At the same time, these drugs have proved so effective at weight loss that US President Joe Biden has proposed subsidising them for millions of obese Americans.

WA doctors believe it could be only a matter of time until Australia follows suit.

Judge only by the optimistic headlines and it is tempting to view semaglutide, and other GLP-1 medications, as a wonder drug.

But experts caution against premature celebration, warning that the new breed of medications — while revolutionary for treating type two diabetes and obesity — are still new, expensive and can come with significant side-effects.

Moreover, not all of the claims made about them stack up — at least not yet.

Australian Medical Association WA president Michael Page said the drugs were an important tool in treating diabetes and, for type 2 diabetics, had clear benefits for the heart and kidneys.

“They are very effective at treating obesity in many patients,” he said. “Beyond those conditions, some of the benefits are a bit speculative and we need a bit more time and adequately designed clinical trials to be sure.”

The Nightly took a look at the evidence for what these drugs can — and cannot — do

TYPE 2 DIABETES

Semaglutide was developed to treat type 2 diabetes, which it does effectively via a weekly injection that encourage the pancreas to make more insulin to keep blood sugar levels in check. In the field of diabetes treatment these medications, sold under various brand names, are regarded as a genuine game changer.

Much as Viagra started as a blood pressure drug before its application for treating erectile dysfunction was discovered, semaglutide’s weight-loss benefits came as a pleasant surprise. One less pleasant side-effect is that some diabetics have struggled to find supplies since it became popular for weight loss.

WEIGHT LOSS

The medical world was excited when GLP-1 drugs were shown to be useful for treating diabetes.

But the rest of the world only woke up when studies found semaglutide, which mimics a naturally-occurring hormone to trick the brain into feeling full, was also great for weight loss.

Soon a flood of celebrities — Amy Schumer and Rebel Wilson were among the few to publicly admit it — were being prescribed the drugs off-label for weight loss. As Jimmy Kimmel joked at last year’s Academy Awards: “When I look around at this room I can’t help but wonder, ‘Is Ozempic right for me?’”

Dr Page said type 2 diabetes and obesity were related conditions.

“So as far as public health is concerned, drugs that can meaningfully and safely tackle diabetes and obesity have been needed for a long time, and this is a class of drugs that can do that,” he said.

“To describe them as a step-change in care much like the statins were in the 80s and 90s would not be unreasonable — remembering, too, that the earliest statins which were a breakthrough in themselves have been superseded by even better ones, so we are likely to see further advances.”

The bad news is that patients who come off the medication tend to quickly regain weight without diet and lifestyle changes to support the weight loss.

HEART DISEASE

In the US, semaglutide was the first weight-loss medication to be approved for patients with serious cardiovascular disease.

One clinical study showed semaglutide was associated with lower rates of heart attack — and strokes — in patients who were obese or overweight but did not have type 2 diabetes. Another found a 20 per cent reduction in heart attack, stroke or cardiovascular-related death in patients taking semaglutide.

Dr Page said semaglutide was beneficial for heart and kidney health for reasons not only related to weight loss.

“Lowered blood sugar, lipids, blood pressure and inflammation are all likely to contribute,” he said.

KIDNEY DISEASE

The evidence that semaglutide can be good for kidney health in patients with type 2 diabetes is strong.

One clinical trial led by UNSW Sydney researchers found a weekly dose of semaglutide reduced the risk of kidney failure or death by 24 per cent in people with both type 2 diabetes and chronic kidney disease.

Whether those benefits extend to people without diabetes is less clear. However, a study by Australian researchers published in The Lancet Diabetes & Endocrinology this week suggested the use of GLP-1 receptor agonists — a category that includes semaglutide, liraglutide, tirzepatide — significantly reduce kidney deterioration and failure, even in non-diabetics.

ALZHEIMER’S

The evidence that semaglutide helps protect the brain may be slimmer than a celebrity on Wegovy but there are some encouraging signs.

One small clinical trial found those taking liraglutide experienced a slower cognitive decline compared to those taking a placebo.

Another study found semaglutide may help lower the risk of Alzheimer’s in people with type 2 diabetes, who are at higher risk of being diagnosed with the degenerative condition. Experts say large clinical trials are needed.

ADDICTION

Some of the evidence that semaglutide can help curb the desire for alcohol, cigarettes and drugs is either anecdotal or comes from animal trials.

Human studies have been mixed. One Scandinavian study found people with alcohol disorders were less likely to be hospitalised for them if they were taking GLP-1 medications. Another found the medications did not reduce smoking rates.

OSTEOARTHRITIS

Being overweight or obese is a significant risk factor for osteoarthritis of the knee. So it may be little surprise that research published last month found semaglutide injections could provide relief from severe knee pain stemming from osteoarthritis.

However, it is not clear whether the results stem solely from the benefits of weight loss, and more studies are needed — ideally not funded by the companies that make the drugs.